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Ki Hyuk Sung, MD

Relationship between rotational gait parameters and torsional bony deformities in patients with diplegic cerebral palsy. Ki Hyuk Sung, MD. Seoul National University Bundang Hospital. Introduction.

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Ki Hyuk Sung, MD

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  1. Relationship between rotational gait parameters and torsional bony deformities in patients with diplegic cerebral palsy Ki Hyuk Sung, MD Seoul National University Bundang Hospital

  2. Introduction • Intoeing gait is a common gait problem in patients with diplegic CP, which affects gait efficacy and cosmesis. • Femoral anteversion and tibial torsion are usually focuses of attention in evaluation and treatment.

  3. Introduction • However, there might be other structural problem affecting rotational gait parameters. • In some clinical situation, degree of femoral anteversion and tibial torsion do not necessarily reflect the severity of the rotational gait problems.

  4. Purpose of the study • To investigate comprehensively relationships between rotational gait parameters and torsional bony alignment, including different deformity types, in patients with diplegic CP

  5. Materials and Methods • Retrospective design • Inclusion • Ambulatory patients with diplegic CP • 3D gait analysis • Torsional CT

  6. 3D gait parameters • Mean foot progression angle in stance • Mean hip rotation • Mean tibia rotation • Mean pelvic rotation • Adjusted foot progression angle • Foot progression angle – pelvic rotation

  7. Radiographic measurements • Acetabular version on CT • Femoral anteversion on CT • Tibial torsion on CT • Knee torsion on CT • AP talo-1st metatarsal angle on weightbearing AP foot radiographs

  8. Acetabular version

  9. Femoral anteversion

  10. Knee torsion

  11. Tibial torsion

  12. AP talo-1st metatarsal angle

  13. Reliability of radiographic measurement • 2 orthopaedic surgeons, 15 patients • ICC (intraclass correlation coefficient) & MAD (mean absolute difference)

  14. Relation btw radiographic measurements & gait parameters • Pearson’s correlation coefficient

  15. Multiple regression anlysis • Structural torsional deformities (CT and radiographic measurements) significantly contributing to adjusted foot progression angle

  16. Results

  17. Conclusions • Adjusted foot pregression angle was more relevant than foot progression angle. • Femoral anteversion and tibial torsion were found to be the significant structural deformities that affect adjusted foot progression angle

  18. Conclusions • However, femoral anteversion and tibial torsion were found to explain only 24.7% of adjusted foot progression angle • Other structural factors or muscle balance need to be considered.

  19. Thank you !

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